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Dr. Maureen Molloy: An 18-year-old healthy man fell headfirst a distance of about 12 ft into 2 ft of water. He was uncertain whether or not he lost consciousness, but from the time of the accident he was unable to move his right arm well. He was taken to a neighboring hospital where x-ray films showed a "dislocation of C-3 on C-4." An adjustable cervical collar was applied, and he was referred to the Massachusetts General Hospital for treatment.
On arrival in the emergency ward, approximately 8 hours after the injury, he was drowsy but could be aroused easily. His blood pressure was 130/80 mm Hg, his pulse 88 beats per minute, and his respirations 18 per minute. There was blood on both lips with a laceration of the midupper gum. His nostrils were crusted with blood.
The patient's chest was clear to percussion and auscultation. Both the diaphragm and intercostal
Aufranc OE, Jones WN, Harris WH. Unilateral Rotary Subluxation of C-3 on C-4. JAMA. 1963;185(13):1031-1035. doi:10.1001/jama.1963.03060130049013